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Showing 1 - 200 of 3175 Journals sorted alphabetically
A Practical Logic of Cognitive Systems     Full-text available via subscription   (Followers: 8)
AASRI Procedia     Open Access   (Followers: 14)
Academic Pediatrics     Hybrid Journal   (Followers: 28, SJR: 1.402, h-index: 51)
Academic Radiology     Hybrid Journal   (Followers: 22, SJR: 1.008, h-index: 75)
Accident Analysis & Prevention     Partially Free   (Followers: 90, SJR: 1.109, h-index: 94)
Accounting Forum     Hybrid Journal   (Followers: 25, SJR: 0.612, h-index: 27)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 33, SJR: 2.515, h-index: 90)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6, SJR: 0.338, h-index: 19)
Acta Astronautica     Hybrid Journal   (Followers: 376, SJR: 0.726, h-index: 43)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 27, SJR: 2.02, h-index: 104)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 8, SJR: 0.172, h-index: 29)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.123, h-index: 8)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.604, h-index: 38)
Acta Materialia     Hybrid Journal   (Followers: 235, SJR: 3.683, h-index: 202)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.615, h-index: 21)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.442, h-index: 21)
Acta Oecologica     Hybrid Journal   (Followers: 10, SJR: 0.915, h-index: 53)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.311, h-index: 16)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1)
Acta Poética     Open Access   (Followers: 4)
Acta Psychologica     Hybrid Journal   (Followers: 25, SJR: 1.365, h-index: 73)
Acta Sociológica     Open Access  
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.059, h-index: 77)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.383, h-index: 19)
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Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 5, SJR: 0.141, h-index: 3)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3, SJR: 0.112, h-index: 2)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 6)
Acute Pain     Full-text available via subscription   (Followers: 14)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.967, h-index: 57)
Addictive Behaviors     Hybrid Journal   (Followers: 15, SJR: 1.514, h-index: 92)
Addictive Behaviors Reports     Open Access   (Followers: 7)
Additive Manufacturing     Hybrid Journal   (Followers: 9, SJR: 1.039, h-index: 5)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Cement Based Materials     Full-text available via subscription   (Followers: 3)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 128, SJR: 5.2, h-index: 222)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 11, SJR: 1.265, h-index: 53)
Advanced Powder Technology     Hybrid Journal   (Followers: 16, SJR: 0.739, h-index: 33)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.299, h-index: 15)
Advances in Agronomy     Full-text available via subscription   (Followers: 12, SJR: 2.071, h-index: 82)
Advances in Anesthesia     Full-text available via subscription   (Followers: 27, SJR: 0.169, h-index: 4)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 1.054, h-index: 35)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 10, SJR: 0.801, h-index: 26)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 22, SJR: 1.286, h-index: 49)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 3.31, h-index: 42)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.277, h-index: 43)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.619, h-index: 48)
Advances in Cancer Research     Full-text available via subscription   (Followers: 28, SJR: 2.215, h-index: 78)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 7, SJR: 0.9, h-index: 30)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 2.139, h-index: 42)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 3)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 12)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 27, SJR: 0.183, h-index: 23)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.665, h-index: 29)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.268, h-index: 45)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 28, SJR: 0.938, h-index: 33)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 19, SJR: 2.314, h-index: 130)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.223, h-index: 22)
Advances in Dermatology     Full-text available via subscription   (Followers: 14)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 10)
Advances in Digestive Medicine     Open Access   (Followers: 8)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 5)
Advances in Drug Research     Full-text available via subscription   (Followers: 21)
Advances in Ecological Research     Full-text available via subscription   (Followers: 42, SJR: 3.25, h-index: 43)
Advances in Engineering Software     Hybrid Journal   (Followers: 27, SJR: 0.486, h-index: 10)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 6)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 42, SJR: 5.465, h-index: 64)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 7)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 54, SJR: 0.674, h-index: 38)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 15)
Advances in Genetics     Full-text available via subscription   (Followers: 14, SJR: 2.558, h-index: 54)
Advances in Genome Biology     Full-text available via subscription   (Followers: 7)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 2.325, h-index: 20)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 21, SJR: 0.906, h-index: 24)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.497, h-index: 31)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 1, SJR: 0.396, h-index: 27)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.152, h-index: 85)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 1.132, h-index: 42)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.274, h-index: 27)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.764, h-index: 15)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 14, SJR: 1.645, h-index: 45)
Advances in Mathematics     Full-text available via subscription   (Followers: 10, SJR: 3.261, h-index: 65)
Advances in Medical Sciences     Hybrid Journal   (Followers: 6, SJR: 0.489, h-index: 25)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.44, h-index: 51)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 21)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.324, h-index: 8)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 3)
Advances in Oncobiology     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 1)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 15, SJR: 2.885, h-index: 45)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 6, SJR: 0.148, h-index: 11)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 2.37, h-index: 73)
Advances in Pediatrics     Full-text available via subscription   (Followers: 24, SJR: 0.4, h-index: 28)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 10)
Advances in Pharmacology     Full-text available via subscription   (Followers: 15, SJR: 1.718, h-index: 58)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.384, h-index: 26)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.248, h-index: 11)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 7)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 17)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 18, SJR: 1.5, h-index: 62)
Advances in Psychology     Full-text available via subscription   (Followers: 59)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.478, h-index: 32)
Advances in Radiation Oncology     Open Access  
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.1, h-index: 2)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 5)
Advances in Space Research     Full-text available via subscription   (Followers: 375, SJR: 0.606, h-index: 65)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 9, SJR: 0.823, h-index: 27)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 29, SJR: 1.321, h-index: 56)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 17)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 13)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 1.878, h-index: 68)
Advances in Water Resources     Hybrid Journal   (Followers: 46, SJR: 2.408, h-index: 94)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 0.973, h-index: 22)
Aerospace Science and Technology     Hybrid Journal   (Followers: 333, SJR: 0.816, h-index: 49)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.318, h-index: 36)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.344, h-index: 6)
Ageing Research Reviews     Hybrid Journal   (Followers: 9, SJR: 3.289, h-index: 78)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 429, SJR: 1.385, h-index: 72)
Agri Gene     Hybrid Journal  
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 15, SJR: 2.18, h-index: 116)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.275, h-index: 74)
Agricultural Water Management     Hybrid Journal   (Followers: 43, SJR: 1.546, h-index: 79)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 1)
Agriculture and Natural Resources     Open Access   (Followers: 2)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 56, SJR: 1.879, h-index: 120)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.434, h-index: 14)
Air Medical J.     Hybrid Journal   (Followers: 5, SJR: 0.234, h-index: 18)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.285, h-index: 3)
Alcohol     Hybrid Journal   (Followers: 11, SJR: 0.922, h-index: 66)
Alcoholism and Drug Addiction     Open Access   (Followers: 9)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.436, h-index: 12)
Alexandria J. of Medicine     Open Access   (Followers: 1)
Algal Research     Partially Free   (Followers: 9, SJR: 2.05, h-index: 20)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.46, h-index: 29)
Allergology Intl.     Open Access   (Followers: 5, SJR: 0.776, h-index: 35)
Alpha Omegan     Full-text available via subscription   (SJR: 0.121, h-index: 9)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 9, SJR: 0.158, h-index: 9)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 48, SJR: 4.289, h-index: 64)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 50, SJR: 3.157, h-index: 153)
American J. of Cardiology     Hybrid Journal   (Followers: 50, SJR: 2.063, h-index: 186)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 42, SJR: 0.574, h-index: 65)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 10, SJR: 1.091, h-index: 45)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.653, h-index: 93)
American J. of Human Genetics     Hybrid Journal   (Followers: 31, SJR: 8.769, h-index: 256)
American J. of Infection Control     Hybrid Journal   (Followers: 26, SJR: 1.259, h-index: 81)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 32, SJR: 2.313, h-index: 172)
American J. of Medicine     Hybrid Journal   (Followers: 42, SJR: 2.023, h-index: 189)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 189, SJR: 2.255, h-index: 171)
American J. of Ophthalmology     Hybrid Journal   (Followers: 62, SJR: 2.803, h-index: 148)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.249, h-index: 88)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, h-index: 45)
American J. of Pathology     Hybrid Journal   (Followers: 27, SJR: 2.653, h-index: 228)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 27, SJR: 2.764, h-index: 154)
American J. of Surgery     Hybrid Journal   (Followers: 37, SJR: 1.286, h-index: 125)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.653, h-index: 70)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 6)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.066, h-index: 51)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 61, SJR: 0.124, h-index: 9)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 14)
Anales de Cirugia Vascular     Full-text available via subscription  
Anales de Pediatría     Full-text available via subscription   (Followers: 2, SJR: 0.209, h-index: 27)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription   (SJR: 0.104, h-index: 3)
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 4, SJR: 2.577, h-index: 7)
Analytica Chimica Acta     Hybrid Journal   (Followers: 39, SJR: 1.548, h-index: 152)
Analytical Biochemistry     Hybrid Journal   (Followers: 165, SJR: 0.725, h-index: 154)
Analytical Chemistry Research     Open Access   (Followers: 10, SJR: 0.18, h-index: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 11)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 1)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 22, SJR: 0.421, h-index: 40)
Angiología     Full-text available via subscription   (SJR: 0.124, h-index: 9)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)

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Journal Cover American Journal of Ophthalmology
  [SJR: 2.803]   [H-I: 148]   [62 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0002-9394
   Published by Elsevier Homepage  [3175 journals]
  • Reduced Efficacy of Low-dose Topical Steroids in Dry Eye Disease
           Associated With Graft-versus-Host Disease
    • Authors: Jia Yin; Ahmad Kheirkhah; Thomas Dohlman; Ujwala Saboo; Reza Dana
      Pages: 17 - 23
      Abstract: Publication date: June 2018
      Source:American Journal of Ophthalmology, Volume 190
      Author(s): Jia Yin, Ahmad Kheirkhah, Thomas Dohlman, Ujwala Saboo, Reza Dana
      Purpose To compare the response of dry eye disease (DED) to treatment with topical steroid in patients with and without graft-vs-host disease (GVHD). Design Post hoc analysis of a double-masked, randomized clinical trial. Methods This single-center study included 42 patients with moderate-to-severe DED associated with (n = 21) or without (n = 21) chronic GVHD. In each group, patients received either loteprednol etabonate 0.5% ophthalmic suspension or artificial tears twice daily for 4 weeks. Clinical data, including Ocular Surface Disease Index (OSDI) questionnaire, corneal fluorescein staining (CFS), conjunctival lissamine green staining, tear break-up time (TBUT), and Schirmer test, were evaluated before and after treatment. Results There were no significant differences in signs and symptoms of DED between the groups at baseline. In non-GVHD patients receiving loteprednol treatment, the average OSDI score decreased by 34% from 49.5 ± 5.9 to 32.6 ± 4.8 (mean ± standard error of the mean, P = .001) and the average CFS score decreased by 41% from 5.6 ± 0.6 to 3.3 ± 0.9 (P = .02). On the other hand, loteprednol treatment in GVHD patients resulted in minimal change in OSDI (59.2 ± 6.7 to 61.1 ± 7.1, 3% increase, P = .66) and CFS (5.5 ± 0.5 to 5.3 ± 1.1, 4% decrease, P = .85) scores. Treatment with artificial tears resulted in 22% decrease of OSDI (P = .10) and 32% decrease of CFS (P = .02) scores in non-GVHD patients, and had minimal effect in patients with GVHD. Conclusions DED patients with ocular GVHD have a less favorable response to a low-dose topical steroid regimen compared with those without ocular GVHD even with similar baseline disease severity.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.024
      Issue No: Vol. 190 (2018)
  • Focal Lamina Cribrosa Defect in Myopic Eyes With Nonprogressive
           Glaucomatous Visual Field Defect
    • Authors: Yu Sawada; Makoto Araie; Hitomi Kasuga; Makoto Ishikawa; Toyoto Iwata; Katsuyuki Murata; Takeshi Yoshitomi
      Pages: 34 - 49
      Abstract: Publication date: June 2018
      Source:American Journal of Ophthalmology, Volume 190
      Author(s): Yu Sawada, Makoto Araie, Hitomi Kasuga, Makoto Ishikawa, Toyoto Iwata, Katsuyuki Murata, Takeshi Yoshitomi
      Purpose To investigate focal lamina cribrosa (LC) defect that spatially correspond to the nonprogressive glaucomatous visual field defect (VFD) in myopic subjects. Design Case-control study. Subjects We included 159 myopic eyes with glaucomatous VFD under treatment and followed up for 7 years. Methods Serial enhanced-depth imaging spectral-domain optical coherence tomography B-scans of the optic discs were acquired at the end of the follow-up and reviewed for the LC defect. Nonprogressive VFD was defined as having ≤1 progressing point of Humphrey visual field, with a slope calculated using pointwise linear regression worse than −1.0 dB/year at P < .01. Eyes were classified as having either progressive or nonprogressive VFD, and associating factors were evaluated. Results Sixty-four subjects (40.3%) exhibited nonprogressive VFD with mean deviation change −0.06 ± 0.22 dB/year. Multivariate logistic regression analysis revealed that presence of LC defect was significantly associated with nonprogressive VFD (odds ratio, 3.96; P = .002). The location of LC defect corresponded spatially to the location of VFD. Nonprogressive eyes with LC defect exhibited lower baseline intraocular pressure (IOP) (16.6 mm Hg vs 21.0 mm Hg, P = .0030) and smaller percentage of IOP change (12.9% vs 30.5%, P < .0001) than those without LC defect, but greater myopic optic disc deformation (10.1 degrees vs 1.2 degrees in torsion angle, P < .0001). When the eyes with LC defect had higher baseline IOP, they exhibited progressive VFD. Conclusions In myopic eyes, there are specific patters of LC defect that are suggested to be associated with nonprogressive glaucomatous VFD.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.018
      Issue No: Vol. 190 (2018)
  • Expanded Retinal Disease Spectrum Associated With Autosomal Recessive
           Mutations in GUCY2D
    • Authors: Maria L. Stunkel; Scott E. Brodie; Artur V. Cideciyan; Wanda L. Pfeifer; Elizabeth L. Kennedy; Edwin M. Stone; Samuel G. Jacobson; Arlene V. Drack
      Pages: 58 - 68
      Abstract: Publication date: June 2018
      Source:American Journal of Ophthalmology, Volume 190
      Author(s): Maria L. Stunkel, Scott E. Brodie, Artur V. Cideciyan, Wanda L. Pfeifer, Elizabeth L. Kennedy, Edwin M. Stone, Samuel G. Jacobson, Arlene V. Drack
      Purpose GUCY2D has been associated with autosomal recessive Leber congenital amaurosis and autosomal dominant cone-rod dystrophy. This report expands the phenotype of autosomal recessive mutations to congenital night blindness, which may slowly progress to mild retinitis pigmentosa. Design Retrospective case series. Methods Multicenter study of 5 patients (3 male, 2 female). Results All patients presented with night blindness since childhood. Age at referral was 9–45 years. Length of follow-up was 1–7 years. Best-corrected visual acuity at presentation ranged from 20/15 to 20/30 and at most recent visit averaged 20/25. No patient had nystagmus or high refractive error. ISCEV standard electroretinography revealed nondetectable dark-adapted dim flash responses and reduced amplitude but not electronegative dark-adapted bright flash responses with similar waveforms to the reduced-amplitude light-adapted single flash responses. The 30 Hz flicker responses were relatively preserved. Macular optical coherence tomography revealed normal lamination in 3 patients, with abnormalities in 2. Goldmann visual fields were normal at presentation in children but constricted in 1 adult. One child showed loss of midperipheral fields over time. Fundus appearance was normal in childhood; the adult had sparse bone spicule–like pigmentation. Full-field stimulus testing (FST) revealed markedly decreased retinal sensitivity to light. Dark adaptation demonstrated lack of rod-cone break. Two patients had tritanopia. All 5 had compound heterozygous mutations in GUCY2D. Three of the 5 patients harbor the Arg768Trp mutation reported in GUCY2D-associated Leber congenital amaurosis. Conclusions Autosomal recessive GUCY2D mutations may cause congenital night blindness with normal acuity and refraction, and unique electroretinography. Progression to mild retinitis pigmentosa may occur.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.021
      Issue No: Vol. 190 (2018)
  • Inter-eye Asymmetry of Optical Coherence Tomography Angiography Vessel
           Density in Bilateral Glaucoma, Glaucoma Suspect, and Healthy Eyes
    • Authors: Huiyuan Hou; Sasan Moghimi; Linda M. Zangwill; Takuhei Shoji; Elham Ghahari; Patricia Isabel C. Manalastas; Rafaella C. Penteado; Robert N. Weinreb
      Pages: 69 - 77
      Abstract: Publication date: June 2018
      Source:American Journal of Ophthalmology, Volume 190
      Author(s): Huiyuan Hou, Sasan Moghimi, Linda M. Zangwill, Takuhei Shoji, Elham Ghahari, Patricia Isabel C. Manalastas, Rafaella C. Penteado, Robert N. Weinreb
      Purpose To investigate inter-eye retinal vessel density asymmetry in healthy, glaucoma suspect, and mild-to-moderate glaucoma subjects, and its potential utility for early detection of glaucomatous damage. Design Cross-sectional study. Methods In 153 subjects including 55 healthy, 32 glaucoma suspect, and 66 glaucoma subjects enrolled in the Diagnostic Innovations in Glaucoma Study (DIGS), vessel density was obtained from optical coherence tomography angiography (OCT-A) macular and optic nerve head scans. Thickness of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (mGCC) was measured with spectral-domain optical coherence tomography (SD-OCT) scans. Inter-eye asymmetry was calculated by taking the absolute value of difference in vessel density and thickness between the right and left eyes. Results Inter-eye retinal vessel density asymmetry parameters were significantly different among the 3 groups. Glaucoma suspects had significantly higher peripapillary and macular inter-eye vessel density asymmetries compared to healthy groups in univariate (1.1% vs 2.0%, P = .014 and 1.2% vs 2.5%, P = .027, respectively) and multivariate analyses (P = .007 and P = .038, respectively). No significant differences in asymmetry of thickness parameters were found between glaucoma suspect and healthy groups (all P > .718). However, significant differences in asymmetry of thickness parameters between glaucoma suspects and glaucoma patients (P < .01) were found for all parameters. Conclusion Inter-eye vessel density asymmetry can be quantified by OCT-A measurement. Glaucoma suspects have significantly greater vessel density asymmetry than healthy eyes. Longitudinal studies are needed to better characterize the relationship of vessel density asymmetry with the development and progression of glaucoma.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.026
      Issue No: Vol. 190 (2018)
  • Dense B-Scan Optical Coherence Tomography Angiography
    • Authors: K. Bailey Freund; Sarra Gattoussi; Belinda C.S. Leong
      Pages: 78 - 88
      Abstract: Publication date: June 2018
      Source:American Journal of Ophthalmology, Volume 190
      Author(s): K. Bailey Freund, Sarra Gattoussi, Belinda C.S. Leong
      Purpose To describe a novel imaging technique, which we call “dense B-scan optical coherence tomography angiography” (DB OCTA), in which thin dense raster scans are used to produce highly resolved structural B-scans with superimposed flow signal that provide precise correlation between retinal microstructure and blood flow. Design Observational case series. Methods Normal eyes and eyes with macular findings of interest were imaged with DB OCTA in which 150-400 OCT B-scans were acquired within a narrow area (from a single line to 1 degree) with a width of 10-30 degrees. B-scans containing 5-7 consecutive frames were processed for OCTA signal and then combined and visualized post-acquisition by application of a Gaussian filter across neighboring scans. The result was a single, smoothed, high-resolution image that contained both structural and flow information. Tracked follow-up DB OCTA was used to detect subtle changes in pathology over time. Results Two hundred and thirty-seven eyes from 205 subjects aged 18-100 years (mean 72.88 ± 14.74 years) with a diverse range of macular findings were imaged with DB OCTA. Highly resolved scans showing precise localization of flow signal were readily obtained, even in patients with poor visual acuity and/or poor fixation. We present clinical examples that demonstrate the utility of DB OCTA for visualizing the associations between retinal microstructure and blood flow. Conclusions DB OCTA enables precise correlation between retinal microstructure and blood flow. The ability to obtain accurately aligned follow-up DB OCTA studies has the potential to refine the understanding and clinical management of a wide range of macular diseases.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.029
      Issue No: Vol. 190 (2018)
  • Peripheral Changes Associated with Delayed Dark Adaptation in Age-related
           Macular Degeneration
    • Authors: Inês Laíns; Dong Ho Park; Ryo Mukai; Rebecca Silverman; Patrick Oellers; Steven Mach; Ivana K. Kim; Demetrios G. Vavvas; Joan W. Miller; John B. Miller; Deeba Husain
      Pages: 113 - 124
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Inês Laíns, Dong Ho Park, Ryo Mukai, Rebecca Silverman, Patrick Oellers, Steven Mach, Ivana K. Kim, Demetrios G. Vavvas, Joan W. Miller, John B. Miller, Deeba Husain
      Purpose To study the association between peripheral changes in Age-related Macular Degeneration (AMD) and dark adaptation (DA). Design Prospective, cross-sectional study. Methods We recruited patients with AMD and a control group (> 50 years) without any vitreoretinal disease. Ultra-widefield (UWF) pseudocolor and fundus autofluorescence (FAF) (Optos Inc, MA) were obtained, and were assessed by two graders for the presence of several peripheral changes in perimacular, mid- and far-peripheral zones. All participants were also imaged with 7 field color fundus photographs used for AMD staging (AREDS system). Both eyes of study participants were tested with the AdaptDx® (MacuLogix, PA) DA extended protocol (20 minutes). Multilevel, mixed-effect models (accounting for correlated outcomes between 2 eyes) were used for analyses. Results We included 128 eyes (n= 72 patients), 75% with AMD and the remainder controls. The presence of reticular pigmentary changes in the mid- (ß= 4.3, p=0.012) and far- peripheral zones (ß= 8.4, p<0.001) was associated with delayed rod-intercept times (RITs), even after adjusting for confounding factors. The presence, number and extent of peripheral classic drusen did not show a similar association (p ≥ 0.148). The presence of a mottled decreased FAF pattern in the mid-peripheral zone was also associated with prolonged RITs (β= 4.4, p= 0.031). Conclusion Our results suggest an association between DA and the presence of peripheral reticular pigmentary changes, as well as the presence of a peripheral mottled decreased FAF pattern. This provides new insights on the clinical significance of peripheral changes in AMD, and their contribution to impairments on DA.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.035
      Issue No: Vol. 190 (2018)
  • Progression of Primary Open-Angle Glaucoma in Diabetic and Nondiabetic
    • Authors: Huiyuan Hou; Takuhei Shoji; Linda M. Zangwill; Sasan Moghimi; Luke J. Saunders; Kyle Hasenstab; Elham Ghahari; Patricia Isabel C. Manalastas; Tadamichi Akagi; Mark Christopher; Rafaella C. Penteado; Robert N. Weinreb
      Pages: 1 - 9
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Huiyuan Hou, Takuhei Shoji, Linda M. Zangwill, Sasan Moghimi, Luke J. Saunders, Kyle Hasenstab, Elham Ghahari, Patricia Isabel C. Manalastas, Tadamichi Akagi, Mark Christopher, Rafaella C. Penteado, Robert N. Weinreb
      Purpose To compare the rates of visual field (VF) loss and retinal nerve fiber layer (RNFL) thinning in primary open-angle glaucoma (POAG) patients with or without type 2 diabetes mellitus (DM). Design Cohort study. Methods A total of 197 eyes (55 eyes of 32 POAG patients with DM in POAG/DM group and 142 eyes of 111 age-matched POAG patients without DM in POAG/DM- group) were included from the Diagnostic Innovations in Glaucoma Study (DIGS). Type 2 DM participants were defined by self-report of DM history and use of antidiabetic medication. The rates of VF loss and RNFL loss were compared in POAG eyes with and without DM using univariate and multivariable mixed-effects models. Results The median (interquartile range) follow-up was 5.7 years (4.0, 6.4). The mean rate of global RNFL loss in the POAG/DM group was 2-fold slower than in the POAG/DM- group overall (−0.40 μm/year vs −0.83 μm/year, respectively P = .01). Although a slower rate of VF mean deviation and pattern standard deviation loss was found in the POAG/DM group compared to the POAG/DM- group, the difference was not statistically significant. Conclusions POAG patients with treated type 2 DM, who had no detectable diabetic retinopathy, had significantly slower rates of RNFL thinning compared to those without diagnosed DM.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.02.002
      Issue No: Vol. 189 (2018)
  • Long-term Outcome of Pars Plana Vitrectomy and Sutured Scleral-Fixated
           Posterior Chamber Intraocular Lens Implantation or Repositioning
    • Authors: Gregg T. Kokame; Ryan T. Yanagihara; Jessica G. Shantha; Kyle N. Kaneko
      Pages: 10 - 16
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Gregg T. Kokame, Ryan T. Yanagihara, Jessica G. Shantha, Kyle N. Kaneko
      Purpose To assess the long-term stability of sutured scleral-fixated posterior chamber intraocular lenses (PCIOLs) performed in combination with pars plana vitrectomy. Design Retrospective, consecutive, interventional case series. Methods Retrospective single-surgeon study of 118 eyes of 111 patients seen at Retina Consultants of Hawaii, who underwent sutured scleral fixation of at least 1 haptic of a posterior chamber intraocular lens with 10-0 polypropylene combined with a pars plana vitrectomy. The fixation knot-tying technique required 2 separate 10-0 polypropylene sutures tied into 1 combined knot—1 suture closed the fixation sclerotomy and created the scleral fixation, and 1 suture looped together around the haptic of the PCIOL, securing the haptic to the scleral fixation site. The primary outcomes were position of the PCIOL at last follow-up, dislocation of either 1 or both haptics of the PCIOL, and breakage of the 10-0 polypropylene fixation suture. Results PCIOLs remained well stabilized and positioned at last follow-up in 116 of 118 eyes (98.3%), with a mean follow-up of 6.0 years. The maximum stable follow-up with 2 intact fixation sutures was 24.75 years. There were 4 cases of redislocation (3.4%), but 2 cases were owing to unstable residual capsular support. There was 1 case of suture breakage in 214 fixation sutures (0.47%) and 1 case of haptic breakage. Conclusions Scleral fixation sutures with 10-0 polypropylene provide excellent long-term fixation of PCIOLs, with a less than 0.5% incidence of suture breakage and documented suture stability for up to 24+ years.

      PubDate: 2018-03-07T10:52:57Z
      DOI: 10.1016/j.ajo.2018.01.034
      Issue No: Vol. 189 (2018)
  • Relation Between Dietary Essential Fatty Acid Intake and Dry Eye Disease
           and Meibomian Gland Dysfunction in Postmenopausal Women
    • Authors: Jillian F. Ziemanski; Lynn R. Wolters; Lisa Jones-Jordan; Jason J. Nichols; Kelly K. Nichols
      Pages: 29 - 40
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Jillian F. Ziemanski, Lynn R. Wolters, Lisa Jones-Jordan, Jason J. Nichols, Kelly K. Nichols
      Purpose To evaluate the relationship between omega-3 (n-3) and omega-6 (n-6) fatty acids with dry eye disease (DED) and meibomian gland dysfunction (MGD). Design Cross-sectional study. Methods Postmenopausal women (n = 439) underwent a clinical evaluation and completed the Vio Food Frequency Questionnaire to estimate their dietary intake of n-3s and n-6s. Subjects were categorized into 2 binary classifications based on whether or not they had (1) DED and (2) MGD. Mean intake of dietary fatty acids was compared with 2-sample t tests. Univariate logistic regression models were used to estimate the odds ratios for each condition associated with each quintile of n-3s, n-6s, and n-6:n-3 ratios. Results For DED vs non-DED, there were no significant differences in n-3 intake (1.95 ± 1.47 g vs 1.92 ± 1.24 g, P = .86), n-6 intake (15.58 ± 11.56 g vs 15.44 ± 10.61 g, P = .91), and n-6:n-3 (8.30 ± 2.57 vs 8.30 ± 2.57, P = .99). For MGD vs non-MGD, there were no significant differences in n-3 intake (1.87 ± 1.35 vs 1.96 ± 1.39, P = .61), n-6 intake (15.26 ± 11.85 vs 15.62 ± 10.93, P = .80), and n-6:n-3 (8.35 ± 2.94 vs 8.28 ± 2.42, P = .84). The odds ratios (OR) for DED did not differ significantly from 1.0 for n-3, n-6, or n-6:n-3. High n-3 consumption (OR = 0.22 [0.06–0.78]) and moderate n-6 consumption (OR = 0.37 [0.15–0.91]) were associated with a decreased frequency of MGD. Conclusions Dietary consumption of n-3s and n-6s showed no association with DED, but high n-3 consumption and moderate n-6 consumption were protective against MGD in this large sample of postmenopausal women.

      PubDate: 2018-03-07T10:52:57Z
      DOI: 10.1016/j.ajo.2018.01.004
      Issue No: Vol. 189 (2018)
  • The Significance of Repeat Cultures in the Treatment of Severe Fungal
    • Authors: Kathryn J. Ray; N. Venkatesh Prajna; Prajna Lalitha; Revathi Rajaraman; Tiruvengada Krishnan; Sushila Patel; Manoranjan Das; Ranjeet Shah; Kavita Dhakhwa; Stephen D. McLeod; Michael E. Zegans; Nisha R. Acharya; Thomas M. Lietman; Jennifer Rose-Nussbaumer
      Pages: 41 - 46
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Kathryn J. Ray, N. Venkatesh Prajna, Prajna Lalitha, Revathi Rajaraman, Tiruvengada Krishnan, Sushila Patel, Manoranjan Das, Ranjeet Shah, Kavita Dhakhwa, Stephen D. McLeod, Michael E. Zegans, Nisha R. Acharya, Thomas M. Lietman, Jennifer Rose-Nussbaumer
      Purpose To identify fungal keratitis patients who are at risk of a poor outcome and may benefit from closer follow-up or more aggressive treatment. Design Secondary analysis of randomized clinical trial data. Methods We compared the clinical outcomes of patients who had positive 6-day fungal cultures with those who did not, using backward stepwise regression with covariates for all baseline clinical characteristics. Subjects : Patients presenting with a smear-positive filamentous fungal ulcer and visual acuity of 20/400 or worse, and who subsequently had a 6-day fungal culture performed at the Aravind Eye Care system (India), Lumbini Eye Hospital (Nepal), or Bharatpur Eye Hospital (Nepal). Main Outcome Measures : The primary outcome is rate of corneal perforation and/or the need for therapeutic penetrating keratoplasty. Secondary outcomes include 3-month best spectacle-corrected visual acuity (BSCVA), 3-month infiltrate and/or scar size, and rate of re-epithelialization. Results Patients who tested positive at their 6-day culture had twice the hazard of experiencing a corneal perforation or the need for therapeutic penetrating keratoplasty (P = .002) than those who tested negative, even after controlling for baseline ulcer characteristics. These patients also had on average 0.26 logMAR lines worse BSCVA at 3 months (P = .001). Culture positivity at day 6 was not a statistically significant predictor of 3-month infiltrate/scar-size (−0.24 mm1; P = .45) or time to re-epithelialization (hazard ratio = .81; P = .31). Conclusions Here we identify a uniquely valuable clinical tool, day 6 culture results, for the treatment of severe fungal keratitis. Risk stratification based on repeat culture positivity is an objective way to assess response to medical therapy and identify patients who are at high risk of a poor clinical outcome. This establishes a new standard of care for severe fungal keratitis management.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.003
      Issue No: Vol. 189 (2018)
  • Distinguishing Keratoconic Eyes and Healthy Eyes Using
           Ultrahigh-Resolution Optical Coherence Tomography–Based Corneal
           Epithelium Thickness Mapping
    • Authors: Niklas Pircher; Florian Schwarzhans; Stephan Holzer; Jan Lammer; Doreen Schmidl; Ahmed M. Bata; Renè M. Werkmeister; Gerald Seidel; Gerhard Garhöfer; Andreas Gschließer; Leopold Schmetterer; Gerald Schmidinger
      Pages: 47 - 54
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Niklas Pircher, Florian Schwarzhans, Stephan Holzer, Jan Lammer, Doreen Schmidl, Ahmed M. Bata, Renè M. Werkmeister, Gerald Seidel, Gerhard Garhöfer, Andreas Gschließer, Leopold Schmetterer, Gerald Schmidinger
      Purpose To find differences in epithelial thickness (ET) maps of eyes with keratoconus (KC) and healthy eyes. Design Institutional cross-sectional study. Methods In this study 40 keratoconic eyes and 76 healthy eyes were scanned using a custom-built ultrahigh-resolution optical coherence tomography system. Automated segmentation ET maps with 17 subsectors were calculated (central, temporal inferior, temporal superior, nasal inferior, and nasal superior area). The thinnest point of the epithelium (minET), the thickest point of the epithelium (maxET), and the thinnest point diagonally opposing the thickest point (ETmax/op) were additional parameters. Ratios were calculated as follows: minET/diagonally opposing point (R1), maxET/diagonally opposing point (R2), inferior temporal area/superior nasal area (RTI/NS), and inferior/superior hemisphere (RI/S). Furthermore, collected parameters were analyzed regarding their diagnostic accuracy (area under the curve; AUC). Results Statistically significant differences were as follows: central ET, 46.25 ± 2.56/50.91 ± 1.66; minET, 38.50 ± 2.10/46.79 ± 1.27; ETmax/op, 47.14 ± 2.45/49.60 ± 1.57; temporal inferior area: 43.93 ± 2.95/51.04 ± 1.51 (all mean ± standard deviation, μm); R1, 0.76 ± 0.09/0.93 ± 0.04; R2, 1.08 ± 0.04/1.21 ± 0.16; RTI/NS, 0.85 ± 0.08/1.02 ± 0.04; RI/S: 0.92 ± 0.07/0.99 ± 0.02. AUC values were R1: 0.979 (confidence interval [CI]: 0.957–1.000), RTI/NS: 0.977 (CI: 0.951–1.000), and minET: 0.928 (CI: 0.880–0.977). Conclusions Epithelial thickness maps could clearly visualize different ET patterns. Parameters with the highest potential of diagnostic discrimination between eyes with KC and healthy eyes were, in descending order, R1, RTI/NS, and minET. Consequently, epithelial thickness irregularity and asymmetry seem to be the most promising diagnostic factor in terms of discriminating between keratoconic eyes and healthy eyes.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.006
      Issue No: Vol. 189 (2018)
  • Influence of Nasal Tear Osmolarity on Ocular Symptoms Related to Dry Eye
    • Authors: Ho Chul Yi; Yoon Pyo Lee; Young Joo Shin
      Pages: 71 - 76
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Ho Chul Yi, Yoon Pyo Lee, Young Joo Shin
      Purpose To investigate relationships between local tear osmolarity and tear film characteristics and dry eye disease (DED) symptoms. Design Prospective, cross-sectional, observational study. Methods Nasal and temporal tear osmolarity were measured in subjects with DED. The difference between nasal and temporal tears (OSM difference) was then calculated. Ocular symptoms were evaluated and tear break-up time (TBUT), corneal fluorescein staining score (CFSS), eyelid hyperemia, and tear production were measured. Correlations between DED symptoms and nasal tear osmolarity, temporal tear osmolarity, OSM difference, and tear film characteristics were evaluated using Pearson correlation analyses. Subjects were divided into 3 groups based on OSM difference: the temporal group had a temporal osmolarity > nasal osmolarity, the nasal group had a temporal osmolarity < nasal osmolarity, and the equal group had an OSM difference < 10 mOsm/L. Results Forty-eight eyes of 48 subjects were included. Eleven eyes were in the temporal group, 17 eyes were in the equal group, and 20 eyes were in the nasal group. Temporal osmolarity, nasal osmolarity, and OSM difference were not correlated with TBUT, CFSS, lid hyperemia, or tear production. Nasal tear osmolarity was correlated with cold sensitivity frequency (r = 0.298, P = .040), foreign body sensation severity (r = 0.293, P = .043), and light sensitivity severity (r = 0.293, P = .043). Additionally, OSM difference was correlated with daily symptom frequency (r = 0.339, P = .019). Conclusions Nasal tear osmolarity and OSM difference play an important role in DED symptoms. Lid hyperemia, TBUT, CFSS, and tear secretion volume are not significantly affected by tear osmolarity. It is important to measure both nasal and temporal tear osmolarity when evaluating patients with DED.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.008
      Issue No: Vol. 189 (2018)
  • Shortest Distance From Fovea to Subfoveal Hemorrhage Border Is Important
           in Patients With Neovascular Age-related Macular Degeneration
    • Authors: Saleema Kherani; Adrienne W. Scott; Adam S. Wenick; Ingrid Zimmer-Galler; Christopher J. Brady; Akrit Sodhi; Catherine Meyerle; Sharon D. Solomon; Rimsha Shaukat; Roomasa Channa; Olukemi Adeyemo; James T. Handa; Jiangxia Wang; Peter A. Campochiaro
      Pages: 86 - 95
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Saleema Kherani, Adrienne W. Scott, Adam S. Wenick, Ingrid Zimmer-Galler, Christopher J. Brady, Akrit Sodhi, Catherine Meyerle, Sharon D. Solomon, Rimsha Shaukat, Roomasa Channa, Olukemi Adeyemo, James T. Handa, Jiangxia Wang, Peter A. Campochiaro
      Purpose To identify factors influencing visual outcome in patients with neovascular age-related macular degeneration (NVAMD) and subfoveal hemorrhage (SFH) treated with anti–vascular endothelial growth factor (VEGF) agents. Design Retrospective case series. Methods Anti-VEGF-treated eyes with SFH > 1 disc area (DA) were identified (n = 16) and changes in visual acuity (VA) and central subfield thickness (CST) from baseline to last follow-up, along with SFH area, thickness, minimum distance from fovea to SFH border, and time to resolution, were determined. Results At baseline, mean (± standard error of the mean) size and thickness of SFH were 14.9 ± 2.8 DA and 386.6 ± 46.9 μm, and mean Snellen VA and CST were 20/250 and 591.7 ± 57.0 μm. Median follow-up was 47.6 months. While more than 50% of patients had VA ≤ 20/200 at baseline and all time points through week 48, the percentage of patients with VA ≥ 20/50 increased to 30%–40% at months 6 and 12 and remained stable through month 48. Spearman rank correlation demonstrated 2 independent variables that correlated with good visual outcome, smaller area of SFH at baseline (r = −0.630; P = .009), and high frequency of anti-VEGF injections (r = 0.646; P = .007). In exceptional patients with good visual outcome despite large baseline SFH, shortest distance between the fovea and hemorrhage border significantly correlated with baseline VA (r = −0.503, P = .047) and final VA (r = −0.575, P = .02). Conclusions Patients with NVAMD and thick SFH, but short distance between fovea and uninvolved retina, can have good visual outcomes when given frequent anti-VEGF injections.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.015
      Issue No: Vol. 189 (2018)
  • Ab Interno Gel Implant–associated Bleb-related Infection
    • Authors: Nathan M. Kerr; Jing Wang; Amanjeet Sandhu; Paul J. Harasymowycz; Keith Barton
      Pages: 96 - 101
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Nathan M. Kerr, Jing Wang, Amanjeet Sandhu, Paul J. Harasymowycz, Keith Barton
      Purpose To examine the presentation and management of 3 cases of bleb-related infection following ab interno gel implant surgery, so as to add to the growing understanding of complications associated with the emerging landscape of newer, minimally invasive glaucoma surgical procedures, and how they are best managed. Design Multicenter retrospective interventional case series. Methods Consecutive cases of bleb-related infection following ab interno gel implant surgery from 2 university-affiliated hospitals were included. Risk factors, visual outcomes, intraocular pressure, and subsequent management were analyzed. Results We report 3 cases of late bleb-related infection occurring after ab interno gelatin stent insertion (8, 7, and 24 months after surgery). One case had blebitis only; the other 2 had bleb-related endophthalmitis. All cases responded rapidly to management of their infections according to standard bleb-related infection protocol, recovering to within 2 lines of their previous visual acuity (6/9, 6/12, and 6/18). Explantation of the devices was not required. Conclusions Bleb-related infections after ab interno gel implant insertion can occur. If infection is treated appropriately, good clinical outcomes are possible.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.014
      Issue No: Vol. 189 (2018)
  • Diagnosing Distensible Venous Malformations of the Orbit With
           Diffusion-weighted Magnetic Resonance Imaging
    • Authors: Evan Kalin-Hajdu; John B. Colby; Oluwatobi Idowu; F. Lawson Grumbine; Jessica M. Kang; Kristin S. Hirabayashi; Christine M. Glastonbury; M. Reza Vagefi; Robert C. Kersten
      Pages: 146 - 154
      Abstract: Publication date: May 2018
      Source:American Journal of Ophthalmology, Volume 189
      Author(s): Evan Kalin-Hajdu, John B. Colby, Oluwatobi Idowu, F. Lawson Grumbine, Jessica M. Kang, Kristin S. Hirabayashi, Christine M. Glastonbury, M. Reza Vagefi, Robert C. Kersten
      Purpose To compare the diffusion-weighted imaging of nonthrombosed distensible venous malformations of the orbit with that of other histologically-proven orbital tumors. Design Retrospective case-control study. Methods Patients with nonthrombosed distensible venous malformations of the orbit and patients with other histologically-proven orbital tumors were selected for chart review. The main outcome measure was the apparent diffusion coefficient of these lesions. Results Sixty-seven patients qualified for chart review; 9 patients had nonthrombosed distensible venous malformations and 58 patients had other histologically-proven tumors. Three of the 9 patients with nonthrombosed distensible venous malformations were initially misdiagnosed as having had solid orbital tumors. The mean apparent diffusion coefficient of distensible venous malformations was 2.80 ± 0.48 × 10−3 mm2/s, whereas the mean apparent diffusion coefficient of other histologically-proven tumors was 1.18 ± 0.39 × 10−3 mm2/s (P < .001). The mean apparent diffusion coefficient ranged from 2.42 to 3.94 × 10−3 mm2/s in the distensible venous malformation group, whereas other histologically-proven tumors ranged from 0.53 to 2.08 × 10−3 mm2/s. Therefore, in this single-institution series, a threshold value of 2.10 × 10−3 mm2/s was 100% sensitive and 100% specific for distensible venous malformations. Conclusion Certain nonthrombosed distensible venous malformations can evade diagnostic suspicion and mimic solid orbital tumors on standard magnetic resonance imaging sequences. In this single-institution series, diffusion-weighted imaging effectively distinguished these nonthrombosed distensible venous malformations from other orbital tumors.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.02.005
      Issue No: Vol. 189 (2018)
  • Evaluating the Usefulness of MP-3 Microperimetry in Glaucoma Patients
    • Authors: Masato Matsuura; Hiroshi Murata; Yuri Fujino; Kazunori Hirasawa; Mieko Yanagisawa; Ryo Asaoka
      Pages: 1 - 9
      Abstract: Publication date: Available online 5 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Masato Matsuura, Hiroshi Murata, Yuri Fujino, Kazunori Hirasawa, Mieko Yanagisawa, Ryo Asaoka

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2017.12.002
      Issue No: Vol. 187 (2018)
  • Is Newer Necessarily Better' The Evolution of Incisional Glaucoma
           Surgery Over the Last 100 Years
    • Authors: Eve J. Higginbotham; Dominique Alexis
      Abstract: Publication date: Available online 13 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Eve J. Higginbotham, Dominique Alexis
      Purpose To examine the progress made in glaucoma incisional surgery and determine if there has been sufficient progress to meet the needs of glaucoma patients. Design Perspective: Literature Review Methods This is a retrospective assessment of key milestones in the evolution of glaucoma incisional surgery and an evaluation of the risks and the benefits of these procedures. Benefits are defined as effective reduction in intraocular pressure (IOP) and protecting visual function, while risks are defined as safety and complications for our patients. Quality of life is also considered. Results Although advances have been made in the last 100 years, the trabeculectomy, a procedure that was described more than 50 years ago remains the optimal choice for reducing IOP among those patients who require pressures in the teens, who do not respond to medications and prior laser therapy. Conclusions Appropriate patient selection, careful attention to surgical technique and intensivefollow up of patients will optimize the results of a trabeculectomy. Newer procedures must be carefully studied in well-designed clinical trials to determine comparative levels of safety and efficacy to this gold standard. Advances in drug delivery and MIGS may ultimately produce the best outcome for glaucoma patients in the future.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.009
  • Proton beam irradiation: a safe procedure in post-equatorial extraocular
           extension from uveal melanoma
    • Authors: Ira Seibel; Aline I. Riechardt; Katharina Erb-Eigner; Alexander Böker; Dino Cordini; Jens Heufelder; Antonia M. Joussen
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Ira Seibel, Aline I. Riechardt, Katharina Erb-Eigner, Alexander Böker, Dino Cordini, Jens Heufelder, Antonia M. Joussen
      Purpose This study was performed to show long-term outcomes concerning metastasis rates and local recurrence rates after primary proton beam therapy in uveal melanoma with posterior extraocular extension (EOE) with the main focus on optic nerve invasion. Design Retrospective case series Methods All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma with posterior EOE between July 1998 and August 2010 were included. EOE was either detected upon sonography at primary examination or during the surgical application of tantalum clips onto the sclera. Ultrasound was performed in each patient before surgery, and if EOE was detected, a magnetic resonance imaging (MRI) scan was performed to confirm EOE. All patients with tumors exceeding 6 mm in thickness or abutting the optic disc received a 1.5 Tesla MRI scan after clip surgery. To asses EOE during follow-up, either ultrasound examinations or—if initially detected only by MRI—MRI scans were performed during follow-up. Results A total of 27 patients underwent primary proton beam therapy. The EOE was separated into 3 growth types: Optic nerve infiltration in 10 patients, vortex vein infiltration in 9 patients, and transscleral growth post-equatorially in 8 patients. No local recurrences were found during the overall median follow-up of 80 months (11-168 months). Metastasis rates correlated with AJCC stages but not EOE volume. Conclusion This study shows that posterior EOE can safely be treated by proton beam therapy, even if the optic nerve is infiltrated. MRI enables safe detection of optic nerve invasion.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.006
  • Automated segmentation of lesions including subretinal hyperreflective
           material in neovascular age-related macular degeneration
    • Authors: Hyungwoo Lee; Kyung Eun Kang; Hyewon Chung; Hyung Chan Kim
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Hyungwoo Lee, Kyung Eun Kang, Hyewon Chung, Hyung Chan Kim
      Purpose To evaluate an automated segmentation algorithm with a convolutional neural network (CNN) to quantify and detect intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), and subretinal hyperreflective material (SHRM) through analyses of spectral domain optical coherence tomography (SD-OCT) images from patients with neovascular age-related macular degeneration (nAMD). Design Reliability and validity analysis of a diagnostic tool. Methods We constructed a dataset including 930 B-scans from 93 eyes of 93 patients with nAMD. A CNN-based deep neural network was trained using 11550 augmented images derived from 550 B-scans. The performance of the trained network was evaluated using a validation set including 140 B-scans and a test set of 240 B-scans. The Dice coefficient, positive predictive value (PPV), sensitivity, relative area difference (RAD), and intraclass correlation coefficient (ICC) were used to evaluate segmentation and detection performance. Results Good agreement was observed for both segmentation and detection of lesions between the trained network and clinicians. The Dice coefficients for segmentation of IRF, SRF, SHRM, and PED were 0.78, 0.82, 0.75, and 0.80, respectively; the PPVs were 0.79, 0.80, 0.75, and 0.80, respectively; and the sensitivities were 0.77, 0.84, 0.73, and 0.81, respectively. The RADs were -4.32%, -10.29%, 4.13%, and 0.34%, respectively, and the ICCs were 0.98, 0.98, 0.97, and 0.98, respectively. All lesions were detected with high PPVs (range 0.94-0.99) and sensitivities (range 0.97-0.99). Conclusions A CNN-based network provides clinicians with quantitative data regarding nAMD through automatic segmentation and detection of pathological lesions, including IRF, SRF, PED, and SHRM.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.007
  • How Are Ocular Signs and Symptoms of Dry Eye Associated with Depression in
           Women with and without Sjögren’s Syndrome'
    • Authors: John A. Gonzales; Annie Chou; Jennifer R. Rose-Nussbaumer; Vatinee Y. Bunya; Lindsey A. Criswell; Caroline H. Shiboski; Thomas M. Lietman
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): John A. Gonzales, Annie Chou, Jennifer R. Rose-Nussbaumer, Vatinee Y. Bunya, Lindsey A. Criswell, Caroline H. Shiboski, Thomas M. Lietman
      Purpose To determine whether ocular phenotypic features of keratoconjunctivitis sicca (KCS) and/or participant-reported symptoms of dry eye disease are associated with depression in women participants enrolled in the Sjögren’s International Collaborative Clinical Alliance (SICCA). Design Cross-sectional study. Methods Women enrolled in the SICCA registry from 9 international research sites. Participants met at least one of five inclusion criteria for registry enrollment (including complaints of dry eyes or dry mouth, a previous diagnosis of Sjögren’s syndrome (SS), abnormal serology (positive anti-Sjögren’s syndrome-related antigen A and/or B (anti-SSA and/or anti-SSB), or elevated anti-nuclear antibody and rheumatoid factor), bilateral parotid gland enlargement, or multiple dental caries). At baseline, participants had oral, ocular, and rheumatologic examination, blood and saliva collection, and a labial salivary gland biopsy (LSGB). They also completed an interview and questionnaires including assessment of depression with the Patient Health Questionnaire 9 (PHQ-9). Univariate logistic regression was used to assess the association between depression and demographic characteristics, participant-reported health, phenotypic features of Sjögren’s syndrome, and participant-reported symptoms. Mixed effects modeling was performed to determine if phenotypic features of KCS and/or participant-reported symptoms of dry eye disease were associated with depression, controlling for health, age, country or residence, and gender and allowing for non-independence within geographic site. Results Dry eye complaints produced a 1.82-fold (95% CI 1.38-2.40) higher odds of having depression compared to being symptom-free (p < 0.001). Additionally, complaints of specific ocular sensations were associated with a higher odds of depression including burning sensation (OR 2.25, 95% CI 1.87-2.72, p < 0.001) compared to those without complaints. In both women with or without SS, the presence of symptoms of dry eyes and/or dry mouth rather than SS itself resulted in higher odds of depression. One particular ocular phenotypic feature of SS, a positive ocular staining score, was inversely correlated with depression. Conclusions Participant-reported eye symptoms, particularly specific ocular sensations such as burning, were found to be positively associated with individual American College of Rheumatology/EUropean Union League Against Rheumatism (ACR/EULAR) SS criteria items.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.004
  • Long-Term Changes in Anterior Segment Characteristics of Eyes with
           Different Primary Angle-Closure Mechanisms
    • Authors: Junki Kwon; Kyung Rim Sung; Seungbong Han
      Abstract: Publication date: Available online 12 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Junki Kwon, Kyung Rim Sung, Seungbong Han
      Purpose To assess long-term changes in the anterior segment (AS) of eyes with different angle closure mechanisms. Design Retrospective cohort study. Methods In total, 133 eyes (from 75 participants) with angle closure were enrolled. All eyes received laser iridotomy (LI) during the follow-up period. Serial anterior segment optical coherence tomography (AS-OCT) imaging was performed during a mean follow-up of 4 years. Participants were categorized into four groups according to angle closure mechanisms, based on baseline AS-OCT images: pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris roll (TPIR), and exaggerated lens vault (ELV). Linear mixed-effect models were applied to evaluate the longitudinal changes in AS-OCT parameters (anterior chamber depth [ACD], lens vault [LV], and angle opening distance [AOD]). Results Forty-six (35%) eyes were classified as PB, 30 (23%) as PIC, 34 (26%) as TPIR, and 23 (17%) as ELV. The follow-up period was 41−54 months. At baseline, ACD was shallowest in ELV, followed by PB, TPIR, and PIC, in order. The PIC group showed significantly wider AOD than the other groups at baseline. ACD decreased and LV increased over time in all groups, especially in the PIC group. After LI, the angle widened in the PB and TPIR groups, but not in the PIC and ELV groups. Conclusions AS parameters changed differently in the four groups. The effects of LI on AOD also differed among groups. Identification of the angle closure mechanism may help predict progressive changes in AS parameters in eyes with angle closure.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.04.005
  • The American Journal of Ophthalmology Will Publish American
           Ophthalmological Society Theses
    • Authors: Richard K. Parrish; Emily Chew; Hans E. Grossniklaus
      Abstract: Publication date: Available online 11 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Richard K. Parrish, Emily Chew, Hans E. Grossniklaus

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.019
  • Genetic and Phenotypic Traits of S. Epidermidis Strains Causing
           Post-cataract Endophthalmitis Compared to Commensal Conjunctival Flora
    • Authors: Christophe Chiquet; Cécile Musson; Florent Aptel; Sandrine Boisset; Pharm; Max Maurin
      Abstract: Publication date: Available online 11 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Christophe Chiquet, Cécile Musson, Florent Aptel, Sandrine Boisset Pharm, Max Maurin
      Purpose The aim of this study was to compare the virulence and antibiotic resistance traits of Staphylococcus epidermidis strains causing acute post-cataract endophthalmitis to those isolated from the conjunctiva of uninfected control patients. Design Case-control study. Methods We isolated a S. epidermidis strain from each of the 22 endophthalmitis patients, and from 43 of the 72 controls. Species identification was confirmed using both Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and tuf gene amplification and sequencing. Antibiotic susceptibilities were evaluated using the AST-P631 card and the Vitek II® automated system. The S. epidermidis strains were tested for the presence of seven virulence genes (icaA, icaB, icaC, icaD, atlE, aap, and capA), the insertion sequence IS256, and the mecA gene. Results The S. epidermidis strains from the endophthalmitis patients displayed higher prevalence rates for aap, atlE, and mecA gene carriage compared to those of the control group (77% vs. 42%, p=0.007; 100% vs 79%, p=0.02; and 54% vs 11%, p<0.001, respectively). They also harbored the combination of the mecA and icaA genes more frequently compared to the control group (13% versus 2%, p=0.01). They were significantly more resistant than control strains to methicillin, fluoroquinolones, and the aminoglycosides. Conclusions A higher capacity of adhesion to the intraocular lens and formation of biofilms as well as greater resistance to antibiotics were found in S. epidermidis strains causing post-cataract endophthalmitis. The usefulness of such virulence and antibiotic resistance markers warrants further evaluation for prevention, treatment, and prognostic evaluation of S. epidermidis endophthalmitis.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.042
  • The safety and efficacy of supraciliary stenting following failed glaucoma
    • Authors: Nathan M. Kerr; Jing Wang; Lucia Perucho; Keith Barton
      Abstract: Publication date: Available online 9 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Nathan M. Kerr, Jing Wang, Lucia Perucho, Keith Barton
      Purpose To evaluate the safety and efficacy of supraciliary stenting following failed glaucoma surgery. Design Interventional case series. Methods Setting: Moorfields Eye Hospital, London, United Kingdom. Study population Twenty eyes from 20 patients with glaucoma refractory to prior glaucoma surgery. Intervention Ab interno microstent (CyPass Micro-Stent; Alcon, Fort Worth, TX) implantation into the supraciliary space. Main outcome measures Outcome measures included the occurrence of ocular adverse events, mean intraocular pressure (IOP) change, and glaucoma medication use through 12 months. Results Mean baseline IOP was 22.5 ± 8.0 mmHg and number of medications was 2.7 ± 1.0. The majority of patients had undergone either prior trabeculectomy or aqueous shunt surgery. There were no serious intraoperative complications or major adverse events following supraciliary stenting. The most common adverse events included transient hyphema (3/20, 15%), transient IOP > 30 mmHg (4/20, 20%), and transient IOP < 6 mmHg (4/20, 20%). At 12 months, mean IOP was 14.9 ± 4.3 mmHg – a 33.7% reduction (P = 0.01). Mean medication usage decreased 56% to 1.2 ± 1.5 at 12 months (P = 0.01). Two patients (10%) required subsequent aqueous shunt insertion. Conclusion Ab interno supraciliary stenting has a favorable safety profile and provides an effective approach to controlling IOP and reducing medication burden in eyes where previous glaucoma surgery has failed.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.043
  • Long-term Progression of Type 1 Neovascularization in Age-related Macular
           Degeneration Using Optical Coherence Tomography Angiography
    • Authors: David Xu; Juan Pablo Dávila; Mansour Rahimi; Carl B. Rebhun; A. Yasin Alibhai; Nadia K. Waheed; David Sarraf
      Abstract: Publication date: Available online 9 April 2018
      Source:American Journal of Ophthalmology
      Author(s): David Xu, Juan Pablo Dávila, Mansour Rahimi, Carl B. Rebhun, A. Yasin Alibhai, Nadia K. Waheed, David Sarraf

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.003
  • Measurement and Associations of the Optic Nerve Subarachnoid Space in
           Normal Tension Glaucoma and Primary Open-Angle Glaucoma
    • Authors: David Fleischman; Hanspeter Esriel Killer
      Abstract: Publication date: Available online 5 April 2018
      Source:American Journal of Ophthalmology
      Author(s): David Fleischman, Hanspeter Esriel Killer

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.01.039
  • Measurement and Associations of the Optic Nerve Subarachnoid Space in
           Normal Tension Glaucoma and Primary Open-Angle Glaucoma
    • Authors: Hanruo Liu; Diya Yang; Teng Ma; Wenyuan Shi; Qiang Zhu; Jun Kang; Ningli Wang
      Abstract: Publication date: Available online 4 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Hanruo Liu, Diya Yang, Teng Ma, Wenyuan Shi, Qiang Zhu, Jun Kang, Ningli Wang

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.023
  • Evaluating the Usefulness of MP-3 Microperimetry in Glaucoma Patients
    • Authors: Marta Beatriz Rodríguez-Cavas; Miguel Tudela-Molino; Monica del-Rio-Vellosillo; María Paz Villegas-Pérez; José Javier García-Medina
      Abstract: Publication date: Available online 4 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Marta Beatriz Rodríguez-Cavas, Miguel Tudela-Molino, Monica del-Rio-Vellosillo, María Paz Villegas-Pérez, José Javier García-Medina

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.02.023
  • Internal limiting membrane peeling in macula-off retinal detachment
           complicated by grade B proliferative vitreoretinopathy
    • Authors: Pauline Foveau; Bertrand Leroy; Jean-Paul Berrod; Jean-Baptiste Conart
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Pauline Foveau, Bertrand Leroy, Jean-Paul Berrod, Jean-Baptiste Conart
      Purpose To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR). Design Retrospective, interventional, comparative case series. Methods: Setting Institutional. Study Population 75 consecutive patients who underwent vitrectomy for primary macula off RD complicated by grade B PVR. Observational Procedures Patients were divided into an ILM peeling (group P) and a no ILM peeling (group NP). Main Outcome Measures Anatomical success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6 months. Results In all, 37 eyes with ILM peeling were included in group P and 38 eyes without ILM peeling were included in group NP. The anatomical success rate after single surgery was higher in group P (89%) than in group NP (66%, p=0.03). Mean final visual acuity was 0.41 ±0.40 logMAR in group P versus 0.43 ±0.22 logMAR in group NP (p=0.82). We found no epiretinal membrane (ERM) formation in group P, whereas five cases of ERM (20%) were detected in group NP (p=0.012). The two groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage. Conclusions ILM peeling during vitrectomy in macula off RD complicated by grade B PVR reduces the need for a second surgery for re-detachment or macular pucker.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.037
  • Long-term choroidal thickness changes in eyes with drusenoid pigment
           epithelium detachment.
    • Authors: Rosa Dolz-Marco; Chandrakumar Balaratnasingam; Sarra Gattoussi; Seungjun Ahn; Lawrence A. Yannuzzi; K Bailey Freund
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Rosa Dolz-Marco, Chandrakumar Balaratnasingam, Sarra Gattoussi, Seungjun Ahn, Lawrence A. Yannuzzi, K Bailey Freund
      Purpose To analyze the changes in visual acuity and subfoveal choroidal thickness in patients with non-neovascular age-related macular degeneration (AMD) and drusenoid pigment epithelium detachments (PED). Design Consecutive observational case series. Methods Observational retrospective review of eyes diagnosed with drusenoid PED in a single clinical setting. Demographic and clinical data included age, gender, laterality, best corrected visual acuity (BCVA) and subfoveal choroidal thickness measured at baseline, before and after the collapse of the PED, and at the last available follow-up. The presence of geographic atrophy (GA) was also assessed. Results Thirty-seven eyes of 25 patients (18 females) were included in the analysis. Mean age at baseline was 71 ± 8.4 years. During a mean follow-up period of 4.9 ±1.9 years, PED collapse was observed in 25 eyes (68%). Mean BCVA, mean maximum PED height and mean subfoveal choroidal thickness significantly decreased from baseline to the last available follow-up (p<0.001) in patients showing PED collapse. Choroidal thinning was faster during the PED collapse (speed rate of 35.9 microns/year). From those, 23 eyes (92%) developed GA. A significant correlation between the area of GA and the decrease in choroidal thickness was found (p=0.010). Conclusions Choroidal thickness significantly decreased in eyes showing drusenoid PED collapse, but not in eyes in which the PED persisted. A significant correlation with resultant GA area following PED collapse and the magnitude of choroidal thinning was found. Further studies are warranted to better understand the mechanisms involved in the occurrence of choroidal changes during the lifecycle of drusenoid PEDs.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.038
  • Spectral Domain Optical Coherence Tomography in Limbal Stem Cell
           Deficiency. A Case Control Study
    • Authors: Nilly Banayan; Cristina Georgeon; Kate Grieve; Vincent M. Borderie
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Nilly Banayan, Cristina Georgeon, Kate Grieve, Vincent M. Borderie
      Purpose To evaluate the efficacy of optical coherence tomography as a non-contact method for imaging the ocular surface in limbal stem cell deficiency (LSCD) and normal eyes. Design Retrospective case-control study. Methods: Setting Institutional. Study population 22 eyes with LSCD (study group, 22 patients) and 10 normal eyes (control group, 10 patients). Observation procedures SD-OCT and confocal microscopy in both the limbal and central corneal zones. Main outcome measures Pachymetry data from the central cornea, presence of the palisades of Vogt, limbal crypts and clear transition between the hyporeflective corneal epithelium and the hyperreflective conjunctival epithelium assessed on cross-sections parallel and perpendicular to the limbus and en face sections of the limbal region. Parallel, perpendicular and en face limbal scores were calculated by adding results of the four limbal quadrants. Results Both the difference between the minimal and the maximal epithelial thicknesses and the epithelial thickness standard deviation were significantly higher in the study group (mean, 47μm/10 μm) compared with the control group (mean, 8 μm/2 μm). The parallel, perpendicular and en face limbal scores were significantly lower in the study group (0.1/0.6/0.2) compared with the control group (7.4/4.8/3.5). Poorer visual acuity was significantly associated with higher standard deviation and difference between minimal and maximal corneal epithelial thicknesses (rs, +0.81/+0.77), lower parallel, perpendicular and en face limbal scores (-0.82/-0.73/-0.82). Conclusions SD-OCT of both the central cornea and limbus with various section orientations is a valuable imaging modality allowing non-invasive and rapid overall precise assessment of both normal and LSCD eyes.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.034
  • Angiopoietin-like 3 is a Potential Biomarker for Retinopathy in Type 2
           Diabetic Patients
    • Authors: Cai-Guo Yu; Sha-Sha Yuan; Long-Yan Yang; Jing Ke; Li-Jie Zhang; Jia-Nan Lang; Da-Wei Zhang; Shao-Zhen Zhao; Dong Zhao; Ying-Mei Feng
      Abstract: Publication date: Available online 3 April 2018
      Source:American Journal of Ophthalmology
      Author(s): Cai-Guo Yu, Sha-Sha Yuan, Long-Yan Yang, Jing Ke, Li-Jie Zhang, Jia-Nan Lang, Da-Wei Zhang, Shao-Zhen Zhao, Dong Zhao, Ying-Mei Feng
      Purpose To investigate whether angiopoietin-like 3 (ANGPTL3) and angiopoietin-like 4 (ANGPTL4) are differentially associated with the severity of retinopathy in patients with type 2 diabetes mellitus (T2DM). Design Cross-sectional study. Methods Serum levels of ANGPTL3, ANGPTL4, high-sensitivity C-reactive protein (CRP), vascular adhesion molecule–1 (VCAM-1), intracellular adhesion molecule–1 (ICAM-1) and vascular endothelial growth factor (VEGF) were quantified by ELISA. Retinal images were recorded to assess the grade of diabetic retinopathy (DR). Multivariable-adjusted logistic analysis was performed to estimate the association of each biomarker and DR stage. Results Among 1192 T2DM patients, 426 (35.7%) had non-proliferative diabetic retinopathy (NPDR) and 56 (4.5%) had proliferative diabetic retinopathy (PDR). After adjusting for covariables, the odds ratios expressing the risk of having DR vs. no DR (n=710 vs. 482) was 1.23 (95% CI, 1.08-1.40, p=0.002) for ANGPTL3; 0.90 (95% CI, 0.79-1.02; p=0.095) for ANGPTL4; and 1.14 (95% CI, 1.00-1.29; p=0.044) for VEGF. The risk of having no DR vs. NPDR (n=710 vs. 426) was 1.16 (95% CI, 1.01-1.32; p=0.036) for ANGPTL3; 0.90 (95% CI, 0.79-1.04; p=0.15) for ANGPTL4; and 1.14 (95% CI, 1.00-1.31; p=0.045) for VEGF. The odds ratios of having NPDR vs. PDR (n=426 vs. 56) was 1.47 (95% CI, 1.03-2.10; p=0.035) for serum ANGPTL3; 0.96 (95% CI, 0.69-1.35; p=0.83) for ANGPTL4; and 1.05 (95% CI, 0.77-1.45; p=0.74) for VEGF. Conclusions ANGPTL3 is independently and strongly associated with DR progression in all stages. Blockade of ANGPTL3 signal in retina might postpone the onset and development of DR in T2DM patients.

      PubDate: 2018-04-15T12:33:39Z
      DOI: 10.1016/j.ajo.2018.03.040
  • Visual function metrics in early and intermediate dry age-related macular
           degeneration for use as clinical trial endpoints

    • Authors: Kimberly J. Cocce; Sandra S. Stinnett; Ulrich F.O. Luhmann; Lejla Vajzovic; Anupama Horne; Stefanie G. Schuman; Cynthia A. Toth; Scott W. Cousins; Eleonora M. Lad
      Abstract: Publication date: Available online 15 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Kimberly J. Cocce, Sandra S. Stinnett, Ulrich F.O. Luhmann, Lejla Vajzovic, Anupama Horne, Stefanie G. Schuman, Cynthia A. Toth, Scott W. Cousins, Eleonora M. Lad
      Purpose To evaluate and quantify visual function metrics to be used as endpoints of AMD stages and visual acuity (VA) loss in patients with early and intermediate AMD. Design Cross-sectional analysis of baseline data from a prospective study. Methods 101 patients were enrolled at Duke Eye Center: 80 patients with early AMD age-related eye disease study (AREDS) stage 2 (N=33) and intermediate stage 3 (N=47) and 21 age-matched, normal controls. A dilated retinal examination, macular pigment optical density measurements, and several functional assessments: best-corrected VA, MAIA mesopic microperimety, dark adaptometry, low luminance VA (LLVA) (standard using a log 2.0 neutral density filter and computerized method) and cone contrast test (CCT) were performed. Low luminance deficit (LLD) was defined as the difference in numbers of letters read at standard vs. low luminance. Group comparisons were performed to evaluate differences between the control and the early and intermediate AMD groups using two-sided significance tests. Results Functional measures that significantly distinguished between normal and intermediate AMD were standard and computerized (0.5 cd/m2) LLVA, percent reduced threshold and average threshold on microperimetry, CCTs, and rod intercept on dark adaptation (p < 0.05). The intermediate group demonstrated deficits in microperimetry reduced threshhold, computerized LLD2 and dark adaptation (p < 0.05) relative to early AMD. Conclusions and Relevance: Our study suggests that LLVA, microperimetry, CCT and dark adaptation may serve as functional measures differentiating early-intermediate stages of dry AMD.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.02.012
  • A Distinct Phenotype of Eyes Shut Homolog (EYS)-Retinitis Pigmentosa is
           Associated with Variants Near the C-Terminus
    • Authors: Jesse D. Sengillo; Winston Lee; Takayuki Nagasaki; Kaspar Schuerch; Lawrence A. Yannuzzi; K Bailey Freund; Janet Sparrow; Rando Allikmets; Stephen H. Tsang
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Jesse D. Sengillo, Winston Lee, Takayuki Nagasaki, Kaspar Schuerch, Lawrence A. Yannuzzi, K Bailey Freund, Janet Sparrow, Rando Allikmets, Stephen H. Tsang
      Purpose Mutations in the eyes shut homolog (EYS) gene are a frequent cause of autosomal recessive retinitis pigmentosa (arRP). This study used multi-modal retinal imaging to elucidate genotype-phenotype relationships in EYS-related RP (EYS-RP). Design Cross-sectional study. Method Multimodal retinal imaging and electrophysiologic testing was assessed for 16 patients with genetic confirmation of EYS-RP. Results A total of 27 unique EYS variants were identified in 16 patients. Seven patients presented with an unusual crescent-shaped hyperautofluorescent (hyperAF) ring on fundus autofluorescence (FAF) imaging encompassing a large nasal-superior area of the posterior pole. Three patients had a typical circular or oval perifoveal hyperAF ring and six patients had no hyperAF ring. Spectral domain optical coherence tomography (SD-OCT) and en face OCT showed preserved ellipsoid zone and retinal thickness spatially corresponding to areas within the hyperAF rings. Eleven patients presented with a rod-cone dystrophy on full-field electroretinogram (ffERG), one patient presented with cone-rod dystrophy, and four patients did not undergo ERG testing. A significant spatial association was found between EYS variant position and autofluorescent phenotype, with variants occurring at a nucleotide position greater than GRch37 6:65300137 (c.5617C) being more associated with patients exhibiting autofluorescent rings at presentation. Conclusions EYS-RP is a heterogeneous manifestation. Variants occurring in positions closer to the C-terminus of EYS are more common in patients presenting with autofluorescent rings on FAF imaging.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.008
  • Outcomes and predictive factors after cataract surgery in patients with
           neovascular age-related macular degeneration. The Fight Retinal Blindness!
    • Authors: Vincent Daien; Vuong Nguyen; Nigel Morlet; Jennifer J. Arnold; Rohan W. Essex; Stephanie Young; Alex Hunyor; Mark C. Gillies; Daniel Barthelmes
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Vincent Daien, Vuong Nguyen, Nigel Morlet, Jennifer J. Arnold, Rohan W. Essex, Stephanie Young, Alex Hunyor, Mark C. Gillies, Daniel Barthelmes
      Purpose To evaluate outcomes and predictive factors of visual acuity (VA) change after cataract surgery in patients being treated for neovascular age-related macular degeneration (nAMD). Design Retrospective, matched case-control study. Methods We studied eyes undergoing cataract surgery that had been tracked since they first started treatment for nAMD. These eyes were compared with a cohort of unoperated phakic eyes being treated for nAMD (three per case) matched for treatment duration before cataract surgery, baseline VA, age and length of follow-up. Results We included 124 patients that had cataract surgery and 372 matched controls. The mean (95% CI) VA gained was 10.6 letters (7.8, 13.2; P < 0.001) 12 months following surgery; 26.0% had gained ≥ 3 lines and 1.6% had lost ≥ 3 lines of VA. Visual acuity (mean [SD]) 12 months after surgery was higher in eyes that had cataract extraction compared with controls (65.8 [17.1] vs. 61.3 [20.8] letters respectively, P = 0.018). The proportion of visits where the choroidal neovascular (CNV) lesion was graded active and the mean number of injections were similar before and after surgery (P = 0.506 and P = 0.316, respectively), while both decreased in the control group, suggesting that surgery modestly increased the level of activity of the CNV lesion. Mean [SD] VA prior to surgery was lower in eyes that gained ≥15 letters compared with eyes that gained 0-14 letters (40.2 [21.4] vs. 62.1 [15.1], P < 0.001). Patients undergoing cataract surgery within the first 6 months of anti-VEGF therapy were more likely to lose rather than gain vision (20.8% lost vision vs. 12.8% and 4.4% gaining ≥15 or 0-14 letters respectively, P = 0.023). Age, receiving an injection at least 2 weeks before surgery, and the CNV lesion type had no discernible association with VA outcomes. Conclusions We found evidence of a modest effect of cataract surgery on CNV lesion activity in eyes being treated for nAMD. Despite this, visual outcomes were reassuringly good. Cataract surgery within 6 months of starting treatment for nAMD should be avoided if possible.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.012
  • Effects of crocin on diabetic maculopathy; a placebo controlled randomized
           clinical trial
    • Authors: Samaneh Sepahi; Seyed Ahmad Mohajeri; Seyedeh Maryam Hosseini; Elham Khodaverdi; Nasser Shoeibi; Maral Namdari; Sayyed Abolghasem Sajadi Tabassi
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Samaneh Sepahi, Seyed Ahmad Mohajeri, Seyedeh Maryam Hosseini, Elham Khodaverdi, Nasser Shoeibi, Maral Namdari, Sayyed Abolghasem Sajadi Tabassi
      Objective Diabetic macular edema (DME) is one of the most important sight-threatening complications in patients with diabetes. Due to neuroprotective properties, crocin, as the main constituent in saffron, is thought to be useful in the treatment and prevention of diabetic maculopathy. The aim of this trial was to evaluate the effects of crocin as a supplement on reducing inflammation in patients with diabetic maculopathy. Design Double blind, placebo controlled, phase 2 randomized clinical trial. Participants In this study, 101 eyes of 60 patients with refractory diabetic maculopathy to conventional therapy including macular photocoagulation and intravitreal injection of anti-VEGF agent (bevacizumab) with or without steroid (triamcinolone) were studied in 3 groups. Intervention Patients in crocin groups received 5mg or 15mg crocin tablets per day for three months whereas; patients in placebo group received one placebo tablet per day during study. The best corrected visual acuity (BCVA), and central macular thickness (CMT) was measured before, every month and 3 months after intervention. Biochemical blood tests were also evaluated before and after trial. Main Outcome Measures The BCVA, CMT were evaluated as the primary outcomes whereas; HbA1c and FBS were studied as the secondary outcomes in this trial. Results 101 eyes were enrolled in this trial and divided in three groups (croicn 5mg n=34, crocin 15mg n=33 and placebo n=34.). According to our data, administration of crocin 15mg tablet per day could significantly decrease (HbA1c) (P-value= 0.024; 95%CI [0.3 to 0.96]), and CMT (P-value=0.005; [95%CI, 32.75-126.99]) and improve BCVA (Log MAR changes; P-value=0.012; [95%CI, 0.23 to 0.69]) compared to placebo group. Although, administration of crocin 5mg tablet per day could clinically improve HbA1c, FBS, CMT and BCVA, the difference was not significant compared to placebo group. Conclusion This study indicated the effect of crocin, as a potent antioxidant and neuroprotective, for treatment of refractory DME in short term; however, the clinical significance is yet to be proved in a study with larger sample size and longer duration of follow-up and also in treatment-naive patients.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.007
  • Six-month longitudinal comparison of a portable tablet perimeter with the
           Humphrey Field Analyser
    • Authors: Selwyn Marc Prea; Yu Xiang George Kong; Aditi Mehta; Mingguang He; Jonathan G. Crowston; Viney Gupta; Keith R. Martin; Algis J. Vingrys
      Abstract: Publication date: Available online 14 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Selwyn Marc Prea, Yu Xiang George Kong, Aditi Mehta, Mingguang He, Jonathan G. Crowston, Viney Gupta, Keith R. Martin, Algis J. Vingrys
      Purpose To establish the medium-term repeatability of the iPad perimetry app Melbourne Rapid Fields (MRF) compared to Humphrey Field Analyzer (HFA) 24-2 SITA-standard and SITA-fast programs. Design Multicentre longitudinal observational clinical study. Participants 60 patients (stable glaucoma/ocular hypertension/glaucoma suspects) were recruited into a 6-month longitudinal clinical study with visits planned at baseline, 2-, 4- and 6-months. Methods At each visit patients undertook visual field assessment using the MRF perimetry application and either HFA SITA-fast (n=21) or SITA-standard (n=39). Main outcome measures The primary measure was the association and repeatability of mean defect (MD) for the MRF and HFA tests. Secondary measures were the point-wise threshold and repeatability for each test as well as test time. Results MRF was similar to SITA-fast in speed and significantly faster than SITA-standard (MRF 4.6±0.1 mins vs. SITA-fast 4.3±0.2 mins vs. SITA-standard 6.2±0.1 mins, P<0.001). Intra-class correlation coefficients (ICC) between MRF and SITA-fast for Mean Deviation (MD) at the four visits ranged from 0.71 to 0.88. ICC values between MRF and SITA-standard for MD ranged from 0.81 to 0.90. Repeatability of MRF MD outcomes was excellent, with ICC for baseline and the 6-month visit being 0.98 [95%: 0.96-0.99]. In comparison, ICC at 6-month retest for SITA-fast was 0.95 and SITA-standard 0.93. Fewer points changed with the MRF although for those that did, the MRF gave greater point-wise variability than did the SITA tests. Conclusions MRF correlated strongly with HFA across 4 visits over a 6-month period, and has good test-retest reliability. MRF is suitable for monitoring visual fields in settings where conventional perimetry is not readily accessible.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.009
  • Reliability and Construct Validity of the NEI VFQ-25 in a Subset of
           Patients with Geographic Atrophy from the Phase 2 Mahalo Study
    • Authors: Sobha Sivaprasad; Elizabeth Tschosik; Audrey Kapre; Rohit Varma; Neil M. Bressler; Miriam Kimel; Chantal Dolan; David Silverman
      Abstract: Publication date: Available online 10 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Sobha Sivaprasad, Elizabeth Tschosik, Audrey Kapre, Rohit Varma, Neil M. Bressler, Miriam Kimel, Chantal Dolan, David Silverman
      Purpose Geographic atrophy (GA) is an advanced form of age-related macular degeneration characterized by progressive, irreversible visual function loss. This analysis evaluates the psychometric properties of the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) Composite, Near Activity, and Distance Activity scores in patients with GA. Design Reliability and validity study. Methods Reliability and validity were tested with NEI VFQ-25 data collected from 100 subjects with GA from United States’ sites of the phase 2 Mahalo study of lampalizumab (NCT01229215). Results Strong internal consistency and reproducibility were demonstrated for the NEI VFQ-25 Composite (Cronbach’s α, 0.95; intra-class correlation coefficient [ICC], 0.86), Near Activity (Cronbach’s α, 0.84; ICC, 0.80), and Distance Activity (Cronbach’s α, 0.84; ICC, 0.84) scores. Convergent validity with the binocular measures, Minnesota Low-Vision Reading Test (MNRead) reading speed and Functional Reading Independence (FRI) Index score, was demonstrated for baseline NEI VFQ-25 Composite (Pearson correlation [r] = 0.61 and 0.69, respectively), Near Activities (r = 0.69 and 0.73), and Distance Activities (r = 0.57 and 0.64) scores. Known-group validity testing for baseline mean NEI VFQ-25 scores (Composite, Near Activities, and Distance Activities) showed differences between patients with mean maximum MNRead reading speed ≥80 vs <80 words per minute, and between mean FRI Index score ≥2.5 vs <2.5 (all P < .001). Conclusions Psychometric evidence supports the NEI VFQ-25 as a reliable and valid cross-sectional measure of the impact of GA on patient visual function and vision-related quality of life.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.006
  • Correlation of immunocytochemistry of BRCA1-associated protein 1 (BAP1)
           with other prognostic markers in uveal melanoma.
    • Authors: Ben J. Glasgow; Tara A. McCannel
      Abstract: Publication date: Available online 9 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Ben J. Glasgow, Tara A. McCannel
      Purpose Prior studies have shown nuclear reactivity for BAP1 yields prognostic information for paraffin embedded uveal melanomas. Lacking are immunocytochemical studies of BAP1 on fine needle aspiration biopsies of uveal melanoma that correlate with prognosis or other markers of prognosis. Our purpose was to fill this gap. Design Experimental laboratory study Methods Fine needle aspiration biopsies were performed prospectively on 113 patients with uveal melanomas garnering limited subsets of cases for comparison. Agreement between immunocytochemistry for BAP1 nuclear staining versus chromosome 3 ploidy analysis and gene expression profiling was assessed by 2 x 2 contingency table analysis. Results The presence or absence of suppression of nuclear expression of BAP1 was strongly associated (73%, P=.000002) with monosomy and disomy chromosome 3, respectively. BAP1 nuclear expression was also correlated with gene expression profiling. Chromosome 3 ploidy analysis correlated with gene expression profiles. Conclusion When adequate material is obtained, immunocytology using BAP1 is a potentially informative tool for prognostication of uveal melanoma.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.005
  • Long-term Effect of Scleral Encircling on Axial Elongation
    • Authors: Dong Hyun Lee; Jong Wook Han; Sung Soo Kim; Suk Ho Byeon; Hyoung Jun Koh; Sung Chul Lee; Min Kim
      Abstract: Publication date: Available online 8 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Dong Hyun Lee, Jong Wook Han, Sung Soo Kim, Suk Ho Byeon, Hyoung Jun Koh, Sung Chul Lee, Min Kim
      Purpose To determine the long-term effect of scleral encircling on the progression of myopia Design Retrospective, clinical cohort study Methods SETTING: Single-center academic hospital (Severance Hospital). STUDY POPULATION The study included seventy-six eyes of 38 patients (mean age 37.21 ± 15.76) who have undergone retinal detachment surgery with scleral encircling Observational Procedures Axial length was measured preoperatively, at 6 months after surgery, and at the most recent visit. They were followed-up for at least 12 months. Main Outcome Measure We compared the changes of axial length per month between operated eyes and contralateral eyes(control group). Results Operated group showed more rapid changes in axial length from 6 months after surgery to the time of the last follow-up than that in control group (0.020 ± 0.033 mm/month vs. 0.002 ± 0.002 mm/month, P= .002; mean follow-up, 26.05 ± 11.39 months). Similar trends were observed during the entire follow-up period (0.065 ± 0.062 mm/month vs. 0.008 ± 0.020 mm/month, P < .001). Subgroup analysis showed that both myopic and highly myopic group showed no significant difference of changing rate of axial length during the first 6 postoperative months (P = .267), from 6 months after surgery to the final assessment point (P= .144) or over the entire observation period (P= .507). Conclusions Encircling the sclera may accelerate progression of myopia by significantly increasing axial length. The degree of myopia itself does not contribute to a significant difference in the increased axial length.

      PubDate: 2018-03-18T11:29:35Z
      DOI: 10.1016/j.ajo.2018.03.001
  • Subtarsal Fibrosis is Associated with Ocular Surface Epitheliopathy in
           Graft-Versus-Host Disease
    • Authors: Ahmad Kheirkhah; Giulia Coco; Vannarut Satitpitakul; Reza Dana.
      Abstract: Publication date: Available online 2 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Ahmad Kheirkhah, Giulia Coco, Vannarut Satitpitakul, Reza Dana.
      Purpose To evaluate occurrence of subtarsal fibrosis in patients with graft-versus-host disease (GVHD) and to determine its association with ocular surface epitheliopathy. Design Cross-sectional study. Methods We enrolled 40 patients with moderate or severe dry eye disease including 20 patients with chronic ocular GVHD and 20 patients without (as the control group). All patients had a comprehensive ophthalmic assessment including evaluation for subtarsal fibrosis, corneal and conjunctival staining, tear break-up time (TBUT), and Schirmer test. Furthermore, meibomian gland drop-out area and densities of epithelial and stromal immune cells were measured using meibography and in vivo confocal microscopy, respectively. Results Subtarsal fibrosis was not seen in any eye of the non-GVHD group. However, 16 eyes (40%) of 10 patients (50%) in the GVHD group had subtarsal fibrosis (P<0.001) with an average involvement of 28.9±13.7% of the tarsal area. Fibrosis was more frequent in the upper lids (35%) than in the lower lids (5%). Regression analyses showed that corneal fluorescein staining was significantly associated with the extent of fibrosis (P<0.001, β=0.14) and TBUT (P<0.001, β= -0.53) but not with other clinical or imaging parameters. Conjunctival lissamine green staining also had a statistically significant association with the extent of fibrosis (P=0.04, β=0.12) but not other clinical or imaging parameters. Eyes with subtarsal fibrosis had a more severe ocular surface epitheliopathy compared with eyes without fibrosis. Conclusions Subtarsal fibrosis is present in a significant percentage of patients with chronic ocular GVHD, likely contributing to the ocular surface damage in these patients.

      PubDate: 2018-03-07T10:52:57Z
      DOI: 10.1016/j.ajo.2018.02.020
  • Autoimmunity, Autoinflammation and Infection in Uveitis
    • Authors: John V. Forrester; Lucia Kuffova; Andrew D. Dick
      Abstract: Publication date: Available online 2 March 2018
      Source:American Journal of Ophthalmology
      Author(s): John V. Forrester, Lucia Kuffova, Andrew D. Dick
      Purpose To review the pathogenesis of uveitis in light of recent advances in our understanding of innate and adaptive immune responses and their regulation. Design A perspective. Methods The methods included a review of prevailing views on the pathogenesis of uveitis, and an analysis of developments in immunology which impact on its conceptual basis, particularly the concept of immunological tolerance and its loss in autoimmunity. Importantly, the role of infection in the pathogenesis of uveitis is evaluated. Results The results comprise a re-appraisal of the pathogenesis of anterior versus posterior uveitis in the context of the blood-retinal barrier and its relation to autoimmune, auto-inflammatory and infectious uveitis. Autoimmunity is seen as a possible cause of certain forms of uveitis but definitive proof is lacking. Auto-inflammatory disease, involving activated innate immune mechanisms, is considered causative in a second set of uveitis conditions. A place for infection in uveitis generally is proposed within a unifying concept for the pathogenesis of uveitis. Conclusion Infection may be implicated directly or indirectly in many forms of non-infectious or undifferentiated uveitis. In addition to the growing recognition that foreign antigen, including re-activatable infectious agents, might hide within ocular tissues, the possibility that a dysregulated microbiome might generate T cells which cause immune-mediated ocular inflammation has now been demonstrated experimentally. An uncontrolled, over-exuberant host immune response may cause continuing irreversible tissue damage even after the infection has been cleared.

      PubDate: 2018-03-07T10:52:57Z
      DOI: 10.1016/j.ajo.2018.02.019
  • Macular displacement after vitrectomy in eyes with idiopathic macular hole
           determined by optical coherence tomography angiography
    • Authors: Tomohiko Akahori; Takeshi Iwase; Kentaro Yamamoto; Eimei Ra; Kenichi Kawano; Yasuki Ito; Hiroko Terasaki
      Abstract: Publication date: Available online 2 March 2018
      Source:American Journal of Ophthalmology
      Author(s): Tomohiko Akahori, Takeshi Iwase, Kentaro Yamamoto, Eimei Ra, Kenichi Kawano, Yasuki Ito, Hiroko Terasaki
      Purpose To determine whether the macula is displaced after vitrectomy with internal limiting membrane (ILM) peeling in eyes with an idiopathic macular hole. Design A retrospective, observational case series Methods Optical coherence tomography angiography (OCTA) was used to obtain 3 mm × 3 mm en face images before and 2, 4, and 8 weeks after the vitrectomy with ILM peeling for 20 eyes of 20 patients with an idiopathic macular hole. The displacements of easily identifiable retinal vessel bifurcations were measured relative to the fovea and the optic disc. Results The distance between the optic disc and vessel bifurcations was significantly shorter in all four quadrants throughout the postoperative period (P<0.001). This distance was significantly greater in the temporal quadrant (P<0.001). The distance of the bifurcations was significantly correlated with the preoperative distance from the optic disc (r=-0.579, P<0.001). A significantly greater downward displacement was observed in the superior quadrant (P<0.001). The change in the angle of bifurcations was significantly correlated with the preoperative angle to the optic disc (r=-0.632, P<0.001). The change in the distance in the inner region was significantly greater than that in the outer region in all quadrants. A significant reduction was observed in the mean FAZ area during the follow-up period. Conclusions The retina in the macular region was displaced nasally probably due to movement of the retina toward the optic disc due to a contraction after the ILM removal. There is also a possibility of a rotation downward by buoyancy from gas tamponade, and centripetal contraction during the process of hole closure.

      PubDate: 2018-03-07T10:52:57Z
      DOI: 10.1016/j.ajo.2018.02.021
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